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The abdominal wall represents a unique structure of dermo-myotendinous conformation that is considered a surgical challenge. The musculocutaneous pedicled flap, using tensor fasciae latae muscle (TFL), is a technique of abdominal wall repair, and it is becoming a more frequent reconstructive procedure. It is a well-suited procedure because it provides both a semirigid fascia layer and adequate skin coverage. We present a case of a 61-year-old man with the diagnosis of squamous cell carcinoma of the bladder, clinical stage IV (T4bN1M1), complicated with an ileo-recal-urethrocutaneous fistula. We reconstructed a massive defect of the abdominal wall by rotating bilateral pedicled TFL flaps. The therapeutic plan comprised 2 surgical procedures. The first surgical intervention was intended to obtain and temporarily fix the flap, and to allow the delay phenomenon to occur. Three weeks later, we performed the abdominal wall reconstruction by repositioning the bilateral TFL flaps and placing a dual prolene with regenerated oxidized cellulose mesh. We performed a successful palliative procedure in a terminal oncologic patient. Combined with a massive oncologic procedure (done by the oncologic surgeon), we were able to solve the cutaneous fistula and provided a significant improvement in the quality of life. The patient was discharged with no procedure-related complications. He has remained healthy 18 months after surgery, and there has been no evidence of ventral hernia. Bilateral TFL flaps represent a viable alternative for primary or secondary abdominal wall reconstruction in selected cases. This reconstructive strategy should be considered when plastic and reconstructive surgeon faces large and complex abdominal wall defects, associated with significant lack of skin cover.
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AbstractFollowing publication of the original article [1], the author reported their given name have been erroneously tagged as their family names.
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BACKGROUND: Fibrosis is a response to chronic liver disease that results in excessive accumulation of extracellular matrix proteins and formation of scar tissue. Fibrosis represents a clinical challenge of worldwide significance. Several studies have demonstrated that many natural products and herbal medicines have activity against liver fibrosis, and extracts of milk thistle such as silymarin and silybin are the natural compounds most commonly prescribed for liver diseases. Therefore, we sought to assess and compare the pharmacokinetic properties and bioavailability of silybin-phosphatidylcholine complex in oily-medium soft-gel capsules and conventional silymarin tablets in healthy Mexican volunteers. METHODS: We enrolled 23 healthy volunteers to participate in a prospective, balanced, blind, single-dose, two-way crossover study with a one-week washout period. Fasting participants received either 45 mg silybin-phosphatidylcholine complex or 70 mg silymarin to assess which formulation provided better bioavailability of silybin. Plasma was obtained and analysed for silybin concentration using a validated ultra-performance liquid chromatography-tandem mass spectroscopy method. Pharmacokinetic parameters were obtained by non-compartmental analysis and values were compared by analysis of variance for a crossover design. Ratios of maximum plasma drug concentration and area under the curve (AUC) were obtained and 90% confidence intervals were calculated. RESULTS: The 23 healthy subjects (11 women, 12 men) who participated in the study were aged 22-31 years old (average: 28), average weight 64.8 kg, height 1.65 m and body mass index 23.5 kg/m2. Plasma levels of silybin were higher after the administration of silybin-phosphatidylcholine complex capsules compared with that after conventional silymarin tablets (P < 0.0001). CONCLUSIONS: The silybin-phosphatidylcholine complex in oily-medium soft-gel capsules seems to provide superior bioavailability. However, clinical studies must be performed to demonstrate its clinical relevance in the treatment of liver diseases. TRIAL REGISTRATION: NCT03440164 ; registered on November 11, 2016.
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Fosfatidilcolinas/farmacocinética , Silibina/farmacocinética , Administração Oral , Adulto , Disponibilidade Biológica , Cápsulas , Estudos Cross-Over , Feminino , Géis , Voluntários Saudáveis , Humanos , Masculino , Silibina/sangue , Método Simples-Cego , Comprimidos , Adulto JovemRESUMO
BACKGROUND: With loss of continuity of the bile ducts after injury, surgery is the only feasible treatment option. Roux-en-Y hepatojejunostomy is the best choice. The use of transhepatic and transanastomotic tubes is still controversial. We evaluated patients who were operated on in which a transhepatic, transanastomotic tube was used because the characteristics of the ducts were inadequate. METHODS: We conducted a retrospective, descriptive study between January 1995 and December 2006 for patients with iatrogenic bile duct injuries with a Roux-en-Y hepatojejunostomy and with placement of a transhepatic and transanastomotic tube. Postoperative evolution was analyzed and postoperative cholangitis was considered as failure. RESULTS: We analyzed 74 patients: 66 patients had one tube, five patients had two tubes and three patients had only one but in the right duct. Mean age of patients was 37 years. Twenty portoenterostomies were done. The tube was removed in 55 patients and 11 continued with the tube, having periodic changes with internal-external biliary drainage. In 21% of the cases, a new intervention (either radiological or surgical) was needed. An adequate quality of life was reported by 64.86% of patients. CONCLUSIONS: Anatomic and structural characteristics are unique for each patient. Use of a tube in the reconstructions of bile duct injuries is limited by the surgeon's experience. Characteristics of the ducts are most important. Therefore, selective use is indicated.
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Ductos Biliares/lesões , Ductos Biliares/cirurgia , Stents , Adulto , Anastomose em-Y de Roux , Anastomose Cirúrgica , Feminino , Humanos , Doença Iatrogênica , Jejuno/cirurgia , Fígado/cirurgia , Masculino , Estudos Retrospectivos , Fatores de TempoRESUMO
BACKGROUND: With loss of continuity of the bile ducts after injury, surgery is the only feasible treatment option. Roux-en-Y hepatojejunostomy is the best choice. The use of transhepatic and transanastomotic tubes is still controversial. We evaluated patients who were operated on in which a transhepatic, transanastomotic tube was used because the characteristics of the ducts were inadequate. METHODS: We conducted a retrospective, descriptive study between January 1995 and December 2006 for patients with iatrogenic bile duct injuries with a Roux-en-Y hepatojejunostomy and with placement of a transhepatic and transanastomotic tube. Postoperative evolution was analyzed and postoperative cholangitis was considered as failure. RESULTS: We analyzed 74 patients: 66 patients had one tube, five patients had two tubes and three patients had only one but in the right duct. Mean age of patients was 37 years. Twenty portoenterostomies were done. The tube was removed in 55 patients and 11 continued with the tube, having periodic changes with internal-external biliary drainage. In 21% of the cases, a new intervention (either radiological or surgical) was needed. An adequate quality of life was reported by 64.86% of patients. CONCLUSIONS: Anatomic and structural characteristics are unique for each patient. Use of a tube in the reconstructions of bile duct injuries is limited by the surgeon's experience. Characteristics of the ducts are most important. Therefore, selective use is indicated.
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Humanos , Masculino , Feminino , Adulto , Ductos Biliares/lesões , Ductos Biliares/cirurgia , Stents , Anastomose em-Y de Roux , Anastomose Cirúrgica , Fígado/cirurgia , Doença Iatrogênica , Jejuno/cirurgia , Estudos Retrospectivos , Fatores de TempoRESUMO
Antecedentes: la rinitis alérgica afecta a 20 millones de personas en Estados Unidos y a un número muy superior en el resto del mundo. Objetivo: evaluar la eficacia y la seguridad de la fexofenadina en comparación con la cetirizina en el tratamiento de la rinitis alérgica. Material y método: se realizó un estudio prospectivo, doble ciego, comparativo, al azar y multicéntrico en pacientes con rinitis alérgica con edades comprendidas entre los 12 y 65 años. En la primera fase se administró placebo durante tres días a todos los pacientes y posteriormente se asignaron por azar para recibir fexofenadina a la dosis de 120 mg o 10 mg de cetirizina en dosis única al día durante 14 días. Al inicio y al final del estu dio se realizaron pruebas de laboratorio y gabinete que sirvieron como parámetros para conocer la inocuidad, eficacia y evaluación global por parte del investigador. Resultados: se incluyeron 176 pacientes, 63.6 por ciento de ellos eran mujeres. La edad promedio fue 27.8 años (ñ 12.0). El 47.7 por ciento de la muestra recibió fexofenadina y 52.2 por ciento cetirizina. No se encontró una diferencia significativa ni en parámetros de eficacia ni en la inocuidad. Conclusión: los resultados de este estudio permiten corroborar la eficacia e inocuidad de la fexofenadina.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Cetirizina , Antagonistas dos Receptores Histamínicos H1 , Rinite Alérgica Perene/tratamento farmacológico , Eficácia , Resultado do TratamentoRESUMO
BACKGROUND: Allergic rhinitis affects 20 million of people in United States and a higher figure all around the world. OBJECTIVE: To evaluate the efficacy and safety of fexofenadine compared with certirizine in the treatment of allergic rhinitis. MATERIAL AND METHOD: It was carried out a prospective, double blind, comparative, randomized and multicentric study in patients with allergic rhinitis, with ages between 12 and 65 years. In the first phase, placebo was administered during three days to all the patients; and then, they were randomly allocated to receive fexofenadine 120 mg or cetirizine 10 mg in one dose a day during 14 days. Laboratory and cabinet tests at the beginning and at the end were performed to value security, as well as a global evaluation of the researcher to estimate effectiveness. RESULTS: 176 patients were included, 63.6% were women, average age was 27 years (+/- 12), 47.7% received fexofenadine and 52.2%, cetirizine. There was not significant difference in parameters of effectiveness nor of security in the studied group. CONCLUSION: The results of the present study confirm the efficacy and safety of the antihistaminic fexofenadine in the treatment of allergic rhinitis.